Baroness Amos: My Lords, I rise to pay tribute to Earl Jellicoe. He was a remarkable man.
	Although we do not recognise the term "Father of the House", which is used in another place, an exception might have been made for Earl Jellicoe, who was a Member of your Lordships' House for 68 years, serving this House in a number of roles. In life, he was characterised by many as an extraordinary individual: full of energy and verve and a truly larger than life figure.
	It is difficult to pay tribute to a life and career that was so full and accomplished across so many spheres. Service and, in particular, public service is an appropriate starting point for this Tribute. Earl Jellicoe had an outstanding war record. He initially joined the Coldstream Guards but was later recruited into the SAS where he became first commander of the Special Boat Squadron, conducting highly dangerous missions into German-controlled Greek islands and, later, Italy and Yugoslavia. For his bravery and success, he was awarded the DSO at the age of 24 and the MC at 26. Foreign Governments also decorated him. He won the Legion d'Honneur, the Croix de Guerre and the Greek War Cross. After the war, he joined the Foreign Office, serving in Washington, Brussels and Baghdad. He resigned in 1958 for personal reasons and, from that point onwards, took a more active role in politics.
	Earl Jellicoe lost his father, the hero of the First World War and Admiral of the Fleet—Sir John Jellicoe and later first Earl of Jellicoe—while he was still at school in Winchester and only 17 years old. Although he inherited his father's title, he could not take his seat until 1939.
	By 1958, when he had retired from the Foreign Service, the Earl had moved from the Cross Benches to the Conservative Benches. His talents and diligence were soon recognised and room was made for him on the Front Bench—first as a Government Whip and later as Joint Parliamentary Secretary in the Ministry of Housing and Local Government and, soon after, as Minister of State for the Home Office. In 1963 he was appointed First Lord of the Admiralty and a year later Minister of Defence for the Royal Navy. In opposition, he served his party as deputy leader and, when his party returned to power in 1970, he was made Lord Privy Seal, Leader of the House and Minister for the Civil Service Department.
	He approached his new role with characteristic vigour and charm. As Leader of the House, he played a significant role in raising the profile and status of this House. Earl Jellicoe reintroduced into the House the tradition of Select Committee work, which had been allowed to lapse since the Second World War. Under his guidance, the Select Committee on Sport and Leisure was set up in 1970. This was soon followed by the Select Committee on the European Community and set in train the tradition of committees of which we are so proud today. It seems hard now to remember a time when this House was not renowned for its work on committees and for the quality of that work, but at that time it was an experiment and one that can only be described as an unmitigated success.
	Lord Jellicoe played another crucial role much later in shaping the committee work of the House. In 1992, he chaired an ad hoc committee on the committee work of this House, whose purpose was to look at the existing committees, consider their reform and extension and compare them with those of the House of Commons. The committee recommended that a permanent committee should scrutinise all Bills to ensure that the delegated powers sought by Ministers were appropriate and subject to the right degree of parliamentary approval. The result was the creation of the Delegated Powers Committee, which remains one of the most respected committees of your Lordships' House. The committee's report also led to a new era in the overall system of Select Committees with the creation of the Liaison Committee.
	Earl Jellicoe often described himself as a reformer in the context of this House. He believed in a partly elected House of Lords based on the regions. Sadly, we will not have the benefit of his experience in our debates on the White Paper on Lords reform in a fortnight's time.
	In 1973, he retired from government and pursued a career in the private sector, but his days of public service were not over. In 1982, he became chairman of the General Medical Council, and for eight years he battled for funding at a time when research budgets were under great pressure. He campaigned for funding to research AIDS when the disease was little known in this country and subject to a great deal of prejudice.
	Earl Jellicoe continued until very recently to play an active role in this House, making contributions to debates on education and Civil Service pension reform, as well as resources for Select Committees. He is survived by four sons and four daughters, and I am sure that the whole House will wish to join me in sending our heartfelt condolences to them all.

Lord Anderson of Swansea: My Lords, it is clear that Iran is playing a negative role, not only in the area mentioned by the noble Lord, Lord Astor, but in other areas—such as encouraging Hezbollah and Hamas. Yet the old Soviet Union played such a negative role in the past, and in response we decided to contain and engage with all the instruments of soft power available to us. Are there not serious lessons to be learned now regarding Iran from that experience, and is it not quite wrong that the US—contrary to our interests and general western interests—refuses to parlay with Iran in areas of important interest worldwide?

Lord Triesman: My Lords, I do not accept the assumptions in the question. The overwhelming proportion of people who apply to come to this country get a visa. A relatively small proportion of those who do not get a visa have been shown by the independent monitor to have had misjudgements made in their case. Of those refused, 4.5 per cent were found to have been refused on the basis of poor judgment.
	Principally the criteria are objective but some assessment must be made about the intent of the person who applies and whether they can honestly convince the entry clearance officer that they intend to leave the United Kingdom on the expiry of their visa. I do not think that human judgment can be completely excluded in these matters, even if the whole platform should be broadly objective.

Lord Janner of Braunstone: asked Her Majesty's Government:
	What progress they can report, following the representations which they, together with other governments or international organisations, have made concerning the release of the three Israeli soldiers captured in Lebanon and Gaza in 2006.

Lord Triesman: My Lords, along with our international partners, including the UN Secretary-General, we continue to call for the Israeli soldiers to be immediately and unconditionally released. We welcome the efforts of regional and international partners who are working to secure their release and have offered our assistance. We believe that the release of the Israeli soldiers would be an important step both for humanitarian reasons and advancing the peace process.

Lord Janner of Braunstone: My Lords, I thank my noble friend for that Answer, with which I fully concur. Does he agree that the need for the return of these kidnapped soldiers is both real and symbolic?It is certainly real for their families and symbolically it would mark one of the first steps that we hope will be taken along the path to peace. Further, has my noble friend seen the leader in the Times today referring to these captive soldiers as such a valuable prize to the terrorists who captured them, it can be assumed that they are still alive and that Hezbollah is in effect preparing for the next war, which it would initiate? In those circumstances, will my noble friend give the House an assurance that efforts to obtain the release of these soldiers will continue as energetically as possible?

Lord Blaker: My Lords, I very much hope the soldiers will be released before long, but might it not help if there were wider negotiations between Israel and the Palestinians, for example, as well as between Israel and some Arab countries? The conditions that Israel sets, backed by the Quartet, before negotiations can begin are that the Palestinians must recognise Israel, renounce violence and accept all previous engagements. Are those conditions really helpful?

Lord Triesman: My Lords, it is hard in any negotiation to talk fruitfully to people who say that you have no right to exist and are prepared to use extreme violence to achieve that end. It does not seem wholly unreasonable that people say, "Let us at least have the basis of an understanding that is peaceable". However, the Government have welcomed the deal brokered by the Saudis, which could potentially produce a partner with whom Israel can bargain fruitfully. Still, I urge that partner itself to desist from a precondition—namely, that it cannot tolerate the existence of the state of Israel—before it starts talking.

Lord Triesman: My Lords, we are helping in a number of ways. We are strong supporters of the United Nations force that is attempting to clear paramilitary and militia detachments from parts of Lebanon, which is not easy; we well understand the extent to which they are embedded in that part of the country. We are trying to ensure that there are discussions among the factions in Lebanon to try and produce a means of sustaining the Government of Lebanon. But, first and foremost, we are trying to ensure that the route map for the Middle East peace process is resuscitated. Without that happening, I doubt we have the preconditions for anything else to succeed.

Lord Williamson of Horton: moved Amendment No. 25:
	After Clause 21 , insert the following new Clause—
	"Children and young people
	After section 142 of the 1983 Act insert—
	"142A Admission to age appropriate setting
	In the case of an application for admission for assessment and treatment for a mental disorder, whether voluntary or not, in the case of any child or young person under the age of 18 years, a clinician with specialist training in child or adolescent mental health shall assess the needs of the child or young person and a PCT or equivalent health board shall provide for such services and accommodation as are sufficient for the particular needs of that child or young person.
	142B Medical assessment by a CAMHS specialist prior to imposition of compulsion for a child or young person
	In the case of a minor under the age of 18, who is admitted for assessment under section 2 or admitted for treatment under section 3, one recommendation as specified in these sections shall, except in an emergency where no child or adolescent mental health specialist is available, be made by a qualified child and adolescent registered medical practitioner.
	142C Clinical supervisor
	Wherever under any provision of this Act a responsible clinician is to be appointed if the patient is a minor under 18 that clinician shall, except in an emergency where no child and adolescent mental health specialist is available, be a child and adolescent mental health specialist.""

Baroness Walmsley: My Lords, I wish to make it quite clear that these Benches support the amendment. Such was the enthusiasm of your Lordships for the amendment that there was no room to add my name to it, but these Benches enthusiastically support it.
	The British Government are a signatory to the UN Convention on the Rights of the Child, which states that,
	"every child deprived of liberty shall be separated from adults unless it is considered in the child's best interest not to do so".
	I know that the Government are doing their very best to implement that responsibility. In fact, great progress has been made within the criminal justice system to do that. We also know that it is the Government's intention that children should be in age-appropriate settings when they have mental health treatment.
	Like the noble Earl, Lord Howe, I am relieved to be able to support the amendment without having to make any additional spending commitment. It is clear from Ivan Lewis's statements that the Government have earmarked the necessary resources to go that step further so that no child will need to go into an adult ward in future.
	If we needed any proof that this amendment were necessary, we have only to read the report of the Children's Commissioner, to which reference has been made. The Minister says that the amendment seeks to enshrine good practice in the Bill; the Children's Commissioner's report makes it clear that that is necessary.

Lord Drayson: My Lords, with the leave of the House, I shall now repeat a Statement made in another place by my right honourable friend the Defence Secretary. The Statement is as follows:
	"Mr Speaker, on 1 February I announced the forthcoming rotation of our troops in Afghanistan. At that time I undertook, once I had spoken with my fellow NATO Defence Ministers at Seville, to update the House on any further changes to our force structure. That is what I am here to do today."First, however, I want to highlight the progress and achievements in Afghanistan during 2006. NATO has continued its expansion of responsibility for this vital campaign into the more challenging south and east of the country. We have faced down the Taliban in its own backyard, delivering security and bringing the reach of the Afghan Government to places that have hardly seen it before. We have unified the military mission under the leadership of General Richards and the British-led Allied Rapid Reaction Corps. Across Afghanistan we have built schools, mosques, roads, wells, and markets. We have defended and reinforced five years of progress, including the first elections in decades, remarkable improvements in education, and the return of five million refugees. "I say this because, before we talk about what more we must do, we should understand what is at risk if we do not continue to live up to the collective commitment we have made to Afghanistan and its people. I am not here to herald this as a job done. I am not painting a glossy picture; our mission in Afghanistan faces serious challenges and the country faces serious problems. But I am here to explain why we must keep working to meet these challenges and secure Afghanistan's future."I have said many times from this Dispatch Box that there is no purely military solution to Afghanistan's problems. What military forces can do, as has been shown right across the country, is increase security. But unless we can help the Afghan Government to bring security to all their people, and convince them that they and NATO are going to defeat the Taliban and others who try to block or destroy progress, everything else we have achieved in Afghanistan will remain at risk. At Seville, NATO's senior military commander, SACEUR, reminded NATO members that it is in the south and east where the security challenge is most acute. He identified a further need for robust, flexible, manoeuvrable combat forces to strengthen NATO commanders' ability to tackle that challenge across these regions."We believe that every NATO partner should be prepared to do more to meet this need. At Seville, some announced they would do so. America promised an additional 3,000 troops. France has offered more close air support. Germany has pledged six reconnaissance Tornados. Lithuania has pledged additional troops. All these contributions are welcome. They build on earlier commitments made at Riga in the autumn, principally by Poland, which committed a battalion to the east. But we must be realistic about how many nations have the ability to take on the tasks facing NATO in the south and east. I have lobbied our partners consistently for more help in these regions, and I will continue to do so. But it is increasingly clear that at present, when it comes to the most demanding tasks in the more challenging parts of Afghanistan, that only we and a small number of key allies are prepared to step forward."This is why we have decided to commit additional forces to Afghanistan. Put simply, the alternative is unacceptable; it would place too great a risk on the progress we have made so far. This is a risk we simply cannot afford to take, both for the sake of Afghanistan and for the sake of our own security. We may be shouldering a greater share of the burden than we might like, but so are others, and we do so in the knowledge that this is a vital mission and one which is directly in our national interest."I now turn to the details of what this decision means in practice. The UK has decided to fill one of SACEUR's most pressing requirements: a manoeuvre battalion for Regional Command (South), an area which covers Helmand—the base and responsibility of the existing UK task force—and the strategically vital neighbouring province of Kandahar, plus the further provinces of Uruzgan, Zabul, Nimruz and Daykundi."We propose to deploy a battle group comprising elements of an infantry battalion, the 1st Battalion the Royal Welsh—The Royal Welch Fusiliers—which will be augmented with a company of Warrior infantry fighting vehicles from 1st Battalion Scots Guards. It will include additional artillery, including a regimental HQ and a battery of light guns from 19th Regiment Royal Artillery, a brigade surveillance group drawn from 5th Regiment Royal Artillery and a troop of guided multiple-launch rocket systems from 39th Regiment Royal Artillery. We shall also deploy additional reconnaissance and surveillance capabilities, four more Harrier GR9s to provide close air support, four Sea King helicopters from 846 Naval Air Squadron to increase our support helicopter capacity and another C-130 Hercules. Some of the forces deployed will be reservists, although I am not yet in a position to inform the House of how many. I will write to confirm that."Overall, that adds up to nearly 1,400 additional personnel. Some will deploy from the roulement in May, but the majority will deploy during the course of the summer. They will be based mostly in Helmand, with some at Kandahar airfield, although they will provide NATO commanders in RC (South) with a flexible capability for use across the southern region. In total, our forces in Afghanistan will increase from about 6,300 to settle at about 7,700 personnel. The current planning assumption remains that those forces are committed until 2009."I am well aware of the pressure under which that will continue to put our Armed Forces. I have made clear in the past that the Government clearly recognise how much we are asking of them. I want to take the opportunity to say again on behalf of the Government how much we admire the professionalism, skill and bravery with which they do the hard and dangerous work we ask of them. I repeat that ensuring that they have the support and equipment they need remains my highest priority. I also want to make clear that we would not make the decision to commit extra forces unless it was in accordance with unequivocal military advice. I and the Chiefs of Staff agree that this additional commitment is manageable."Before closing, I want to address some misconceptions about this decision which have circulated over recent days. The first is that our recent decisions on Iraq were driven by our desire to do more in Afghanistan. That gets things the wrong way round. Our planned drawdown in Iraq, announced by my right honourable friend the Prime Minister last week, is driven by conditions on the ground. It is the situation in Iraq that determines what we do there, not the situation in Afghanistan. But of course our plans for Iraq and our other operational theatres, including the Balkans, affect our ability to do more in support of NATO in Afghanistan. In that context, our decision last week on Iraq makes today's decision that much easier."The second misconception is that that enhancement reflects poor planning in the first place. That is simply not true. As a general point, it is wrong to suggest that any enhancement must reflect poor planning. Inevitably, much is learned during a deployment, especially in the early stages, and the force structure should adapt. That is what happened last summer. But it is a straightforward error to interpret today's decision as implying anything about the adequacy of the Helmand task force. That force is clearly up to the job: it overmatched the Taliban in every engagement last summer, and over the winter it has been able to take the fight to the Taliban on our terms, while at the same time securing the area around the provincial capital, and also securing vital reconstruction projects such as the Kajaki Dam. Today's decision is a commitment to the southern region as a whole. These additional forces will meet NATO's requirement for troops who can work across the region, in Kandahar and elsewhere. They provide commanders with greater flexibility, and greater capacity to support the Afghan military while they develop the skills and confidence to do this vital work for themselves, which remains, as I have said before, our long-term exit strategy."I assure the House that, in announcing this significant additional commitment, my resolve to secure contributions from others to share this burden remains undiminished. But I put it to the House that we must protect the progress we have made so far, and protect the Afghans' own hope and determination. That is this Government's intention. We believe in this mission, we believe in the international community's aims in Afghanistan, and we are proud to play our full part in achieving them".

Lord Astor of Hever: My Lords, I thank the Minister for repeating the Statement. This announcement comes as no surprise to us; it has long been clear that more forces are needed in Afghanistan to maintain sufficient security levels to allow redevelopment and to withstand the offensive of a rejuvenated Taliban. Indeed, General Richards requested more troops this time last year but was denied them. We on these Benches share the Statement's admiration for the professionalism, skill and bravery with which our Armed Forces do the hard and dangerous work in Afghanistan. Indeed, the fighting there has been the fiercest since the Korean war. Can the Minister confirm that our troops will get the resources and equipment they need? Some of the equipment there is now very tired, and helicopters are flying at the limit of their hours. Most of these new troops are earmarked for Helmand, where the fighting is at its fiercest and most dangerous. This is hardly a reduction in the overall workload of the Armed Forces, notwithstanding the Government's withdrawal of troops from Iraq.
	Only a few weeks ago, the Government announced that they would be sending 600 extra troops to Afghanistan. Today, this figure has more than doubled. The Government have failed to get our NATO allies to pull their weight and help to supply the extra manpower needed. This country and a small number of allies are already contributing more than our fair share, both in numbers and the dangers faced. At this point, I unreservedly compliment the Canadians, whose ongoing efforts in Kandahar in very hostile conditions are essential to the success of the NATO mission. However, I refer to some of our European allies, who, in the words of one Army officer to whom I spoke, are offering a mere "ornamental presence". This very public show of indifference on the part of powerful nations has encouraged the Taliban's resurgence. This is the third or fourth time that British troops have had to reinforce since the war began, while some of our allies remain reticent. What are the Government doing to address this imbalance? Are we going to continue to carry the can for our NATO partners, who are accepting the benefits of the NATO security guarantee but leaving it to our taxpayers to meet the financial burden and our troops the military burden?
	Given the current levels of overstretch, our concerns must be for the safety of the troops already deployed and that their efforts are neither compromised nor wasted. Senior officers have commented over the weekend that, even with these reinforcements, troop levels are still unlikely to be enough. If, after sending these reinforcements, commanders on the ground request extra troops at some point in the future, will the Government be able to find them, and will they send them? One result of the shortage of troops is the increased reliance on airpower, which has caused higher civilian casualties. Indeed, last year this led to the highest casualty figure since 2001. I myself have spoken to several soldiers of all ranks who have returned from Afghanistan, and they told me how effective they found the Apache helicopter. Can the Minister reassure the House that there will be no reduction in either the number of Apaches or the budget for the vital job of training Apache pilots?
	The Afghanistan campaign can be considered a success only if there is lasting reconstruction in the area. Hearts and minds can be won only if the local people see real and visible benefits arising from our continued presence. I was heartened to hear a brief mention in the Statement of rebuilding projects, but have the Government appreciated the significance of reconstruction, and can they support their words with actions? Soldiers returning from Afghanistan say that they have the impression that DfID has effectively pulled out of the area. Can the Minister confirm whether this is the case? If DfID has pulled out, it is essential that the Government seriously consider other options. Will they consider giving the Army a larger reconstruction budget with which it can help to rebuild the area? Further, can the Government persuade their NATO allies, who are so reluctant to commit troops, instead to commit to the reconstruction effort? If the good work of our troops, not to mention a death toll of 48, is not to be in vain, there simply must be an effective reconstruction campaign. We have spent 10 times as much on military operations as on reconstruction. Only when there is evidence of successful reconstruction will there be local support.

Lord Garden: My Lords, I add my thanks to the Minister for repeating the Statement; however, I am absolutely astonished that we are only being told this today. On Tuesday of last week the Minister came to the House to talk about military matters, on Wednesday the Leader of the House repeated the Prime Minister's Statement on troop reductions in Iraq, and on Thursday we had a five-hour debate on Iraq, with the noble Lord, Lord Triesman, answering for the Government. By that evening the media had wind of this announcement and all our phones were ringing. Afghanistan changes were not mentioned by any of the Ministers last week, and the Statement argues that the decrease in Iraq and the increase in Afghanistan are unrelated. That is a totally disingenuous argument. As the Minister knows, noble Lords from all sides of the House have been greatly exercised about the over-tasking of our military over a very long period. Any small relief that might have resulted from reductions in Iraq will now be negated by the increase in Afghanistan. Nor does the argument that the Chiefs of Staff believe that this is "manageable", the word used in the Statement; it simply does not wash. It is the responsibility of the Government to set the commitment of the Armed Forces at a level which is sustainable for the resources they have been given. The Government have exceeded that level for the past eight years and seem not to care.
	Members on these Benches support a focus on the Afghanistan operation and believe that the forces needed to do the job must be provided if we can. We do not enter into the counterproductive abuse heaped by some on our NATO allies. Indeed, the Statement this time is more critical in that regard. They held the fort in Afghanistan while we were away invading Iraq. Those forces are there still in the north and the west, and they are present in much larger numbers in the Balkans, while European forces are in Lebanon when UK forces are not. If we end up in an arguing match with our NATO allies, we will damage the alliance.
	We were very much in the lead in our enthusiasm for the new plan in the south and east of Afghanistan and we therefore had a duty to ensure that we had adequate forces on call before starting. At least now we are trying to establish the appropriate force with the reserve that we should have had in the first place.
	I too have a number of questions for the Minister. The Statement talks about four extra Sea King helicopters to support this manoeuvring force over most of the south of Afghanistan. I shall not go into the technical capabilities of the Sea King helicopter, but it seems a fairly massive task for the very small and inadequate force which will be asked to manoeuvre around. We still need more helicopters, and these will not be the answer to the problem, particularly in the summer. How is the Minister getting on with his longstanding task of procuring extra support helicopter capability? What effect will all this have on the air bridge? Has that been looked at? How is he getting on with procuring more for the air bridge?
	It seems strange that we do not have any breakdown in the new force structure between reserves and regulars, but we will learn about it later. How is it that we have put together a force where we do not know which are regulars and which are reserves?
	What effect will the problems with the Nimrod force, which is currently in difficulty, have on our operations in Afghanistan?
	With regard to the morale of our troops, this may sound as if it is a long way from operations in Afghanistan, but it will be important to them: when will the Armed Forces Pay Review Body report be published? It is now more overdue than it has ever been, and it will be taken by the troops as a signal of how much the Government value what they are doing.
	How do the Government reconcile the claim that we should be operating within the defence planning assumptions by the end of this year with the new announcement? Has that gone back as well? When was this new level of force decided? What notice did the Government have that they had to increase the forces to this level?
	Has there been any progress between the US and the UK on agreeing an appropriate strategy for the opium harvest? That affects what these troops will be engaged in. Has there been any progress on control of the Afghan-Pakistani border?
	There are many questions that need to be answered. While we support this deployment, I repeat what I said in Thursday's Iraq debate: dividing our assets between two campaigns is not a recipe for success in either. We need to withdraw from Iraq and concentrate on Afghanistan. Today's Statement has strengthened my view that time is running out, and it is the British Armed Forces that will suffer.

Lord Craig of Radley: My Lords, I thank the Minister for repeating the Statement and for the extensive responses to the questions and points made from the Opposition Benches. I do not think that it is any surprise that there has been this need for further deployment of front-line troops into Helmand province. General Richards, at his handover, and many experienced observers, have been convinced of the need for additional effort to face down the Taliban.
	Can the Minister reassure the House that the commanders in theatre have not been requesting more than the 1,400 or so extra forces mentioned in this Statement and that it is not the intention of Her Majesty's Government to increase yet further the number of forces deployed to Afghanistan before there is a considerable reduction in those deployed in Iraq? As the Minister has observed and acknowledged, we are extremely extended by having to mount operations in two theatres for this much extended period. Therefore, it would be very reassuring to know that there is no intention to increase further in Afghanistan before we have achieved on the ground considerable reduction of our effort in Iraq.

Lord Wright of Richmond: My Lords, I apologise for not having been here for the Statement and also apologise if it covered the question that I ask. Has serious thought been given to turning some of the poppy crop into pharmaceutical purposes in order to reduce the hardship that undoubtedly follows from the destruction of the poppies?

Lord Drayson: My Lords, on the face of it, it seems ridiculous that that should not happen when there is a shortage of pharmaceutical grade narcotics. However, the matter has been looked into very carefully indeed. It is the policy of the Afghanistan Government not to support such an initiative because of the practical challenges that it would present. I sympathise with the noble Lord's suggestion. It should be possible to do what he suggests.

Lord Williamson of Horton: My Lords, this amendment was tabled in Committee by the noble Baroness, Lady Howells of St Davids, whose name is again attached to it, and spoken to by the noble Baroness, Lady Massey, who has now moved on to even greater things.
	I draw the Minister's attention to the fact that this is what I described on the last occasion as the mini-amendment; that is, it deals with advocacy for children and young people. It does not deal with the other question of advocacy. I did not retable that amendment, although the noble Lord, Lord Patel of Bradford, has done so, and it is not grouped with this amendment. I will deal only with the question of advocacy for children.
	We have convincing evidence that children and young adults who are admitted to in-patient units do not always have information and are subject to confusion and fear. That is shown, for example, by the report from the office of the Children's Commissioner, which was specific on this point. I want briefly to refer to two elements. The Children's Commissioner made it clear that difficulties did arise and quoted specific examples, so we are basing our argument to a considerable degree on facts and evidence. Many of the young people were dissatisfied and unhappy about the in-patient services. In one case, no education was made available, although the patient was well within the "young" category for education. We believe that a specific requirement to make advocacy available to children and young people would be helpful in preventing them from switching off from the services and that it would provide a better basis for treatment and rehabilitation.
	The amendment is in line with the national service framework for children. In our view, the costs would not be high—perhaps about £100,000 a year for compulsory admissions and up to £1 million for all children and young people. In so far as the Minister may insist that much of this work is already being done, the new expenditure is correspondingly lower.
	I have brought this amendment forward now because it would be helpful to have the Minister's assurances about the action that the Government and the authorities are encouraging in this area. That is what we are interested in; we want to know that we are making progress in making advocacy for children and young people more widely available. I beg to move.

Baroness Walmsley: My Lords, we on these Benches also support the amendment. The Minister will know that there are precedents for groups of people having a right to advocacy services. The Mental Capacity Act 2005 enshrines the right to advocacy for people lacking capacity through the independent mental capacity advocacy service, and the Adoption and Children Act 2002 gives young people looked after by the state the same right to advocacy.
	There are many reasons why a young person may need an independent person on whom they can rely to express their wishes to the appropriate authorities. I am particularly concerned about the right to education. The Children's Commissioner report contains a case study about a young woman called Amber, who was not offered any education during her seven-month stay on the adult psychiatric ward, despite being 14 at the time of her admission. A child's right to education and all the other rights are matters with which an advocate would be able to help them. An advocate could also ensure that children were properly informed, understood the treatment that was being made available to them, and many other matters. I support the noble Baroness, Lady Howells, on this.

Baroness Royall of Blaisdon: My Lords, this amendment is intended to ensure that advocacy services are available to all patients with a mental disorder aged 18 years or under. We recognise that there are certain groups of patients who will receive particular benefit from advocacy services and we have noted the views of the Children's Commissioner. The noble Lord, Lord Patel of Bradford, and my noble friend Lady Howells of St Davids brought to our attention in our debate in Committee the experience of people from black and minority-ethnic communities treated under the Mental Health Act. In particular, they stressed that:
	"Culturally competent advocacy can improve therapeutic alliances and find culturally, socially and racially responsive resolutions to conflict where it arises".—[Official Report, 17/1/07; col. 691.]
	The noble Lords were, of course, absolutely right, in that properly trained, specialist advocacy can be of greater benefit to particular groups of patients than more generalised advocacy. The work that the Government have commissioned to develop training and standards for advocates, which is currently under way, is looking at the needs of particular groups from within the population of patients with mental disorder.
	In Committee, we said that we would take away the issue of advocacy and consider the best way to make advocacy services available. I want to assure the House that we are making progress. I am unable to confirm how we will proceed, as we wish to continue with that work before the Government announce how they will take this issue forward. We have listened not only to the strength of feeling expressed by noble Lords in Committee but also to their comments about the need for a service that will take account of the differing needs of different groups of patients.
	The amendment would provide that all patients aged 18 years or under would have access to these services. The Act provides that a patient is any person suffering from a mental disorder or appearing to suffer from a mental disorder. That person need not be in hospital or under the supervision of a specialist doctor. There is a wide range of conditions and situations that fit into that definition. Of course, I do not wish to underestimate the significance of any person who is living with a mental health problem. However, I wonder whether this would provide for a service that would effectively target resources to those in need.
	I am aware that many younger child patients who are in hospital for their mental disorder are not subject to the Mental Health Act where their parents provide consent for their treatment, as my noble friend Lady Howells outlined. In considering the best way to provide for advocacy services, I well understand that it is important that this group must not be forgotten.
	As we said in Committee, we are considering the best way in which advocacy services can be made available, taking into account the differing needs of different groups of patients. We wish to see tailored advocacy services, which will bring the maximum benefit to all groups of patients, including children and young persons. We have not, however, been able to get provisions ready in time for Report stage.
	The Government will continue to develop their proposals on how patients with mental disorder who are subject to the Mental Health Act can access appropriate advocacy services and we will bring them back when the Bill is considered in the other place. Indeed, in considering this subject we would be very happy to discuss our proposals with noble Lords who are interested in doing so. We very much hope that they will help us on this. As such, I hope that the noble Lord will feel able to withdraw his amendment.

Earl Howe: My Lords, in speaking to Amendment No. 33B I shall raise an issue that has caused considerable and deep divisions between the Government and the mental health community, namely, the conditions which should determine the threshold of entry on to a community treatment order. I shall speak also to Amendments Nos. 36A, 47 and 59.
	The Minister should note that, in moving this amendment, I do not oppose CTOs outright, even though there is a strong argument for doing exactly that. If there was one speech in Committee that summed up the intellectual case against CTOs, it was that of the noble Baroness, Lady Meacher. The supposed effectiveness of CTOs as proclaimed by the Government is not backed up by any convincing evidence. Even more serious than that, there is a real risk that the coercive element in CTOs will undermine the whole basis on which community mental health services are provided through assertive outreach teams and the rest. Those services depend for their success on positive engagement and trust. It is very difficult to have benevolent treatment and coercion operating side by side; indeed, some would say that it is impossible. At the very least, the combination sends a very mixed message to the patient.
	The Minister seems to take it as self-evident that being on a CTO is better for a person than being detained as an in-patient because it is less restrictive, but he overlooks an important fact: although a patient may have been ill enough to be placed in hospital at the outset of the process, by the time the issue of discharge arises, that is no longer the case. At that stage, the issue is whether a person who is well enough to enter the community should remain under the enforceable and coercive power of an order. It is by no means self-evident that, for the generality of patients, continuing coercion represents an ethical or therapeutically effective way forward.
	We have to be clear that these orders are likely to be exceedingly restrictive in some cases. Clinicians will need to think carefully before imposing them because there is no doubt that any CTO will interfere with a person's family and private life, sometimes severely. Yet the Bill tends to encourage the opposite approach—the noble Baroness, Lady Meacher, made this point—because it is framed in such a way as to put pressure on professionals to impose CTOs, even when they may not really wish to, purely to cover their own backs. I do not think we should put professionals in that position, which is one of the main reasons why I feel we owe it to them and patients to define as closely as we can the cohort of people whom we are prepared to accept could be made subject to an order.
	The amendments take as their starting point a premise that I am not sure the Minister has ever really accepted, which is that, leaving aside people who fall within Part 3, patients who retain full decision-making powers in relation to their own treatment should normally be allowed to take control over their own lives, just as anyone with any other health condition should be able to. Only where decision-making powers are impaired is there an ethical case for compulsion. Furthermore, I believe that those who are not a serious risk to others can be treated satisfactorily by the existing provisions of the Mental Health Act relating to leave of absence and supervised discharge.
	Although supervised discharge is little used, it has been proven to be effective in most of the cases in which it has been used over a wide range of clinical and social problems. It is suited to patients who are in hospital under compulsion and whose condition has stabilised to the extent that they do not require close hospital supervision but who are not well enough to be fully discharged from medical care. It is a supportive regime that strengthens rather than weakens the therapeutic relationship. One of the interesting features of the research into the use of Section 25 supervised discharge is that it improves compliance with medication. The absence of a coercive element does not seem to matter. Apart from the fact that that finding calls into question the whole rationale for CTOs, it provides good grounds for leaving out Clause 30 and retaining the option of supervised discharge. If one accepts that—and the vast majority of mental health professionals do—it is clear that we need to exclude from the ambit of CTOs any patient who represents no serious risk to others and can take balanced decisions about his or her own treatment.
	So what kind of patient is a CTO potentially suited to? The Government's argument for the use of CTOs has focused on cases where a person poses a serious risk to others. The thought is that this group of people will benefit particularly from the blend of supervision, care and control and the possibility of recall that a coercive outpatient system provides. As far as hard evidence goes, the jury is still out on whether that assumption is valid in the sense of CTOs being able to prevent homicides. We simply do not know. However, in an effort to be fair to the Government, I am willing to take their belief at face value for the purposes of the Bill. Accordingly, the amendment states that those who pose a serious risk of harm to others should be liable to be placed under a CTO; furthermore, they should be people whose ability to make decisions about receiving medical treatment is significantly impaired. In a nutshell, we are dealing with patients who do not, at the relevant time, accept that they are a risk to others, despite being advised that they are, because of the nature of their mental disorder. In the accepted jargon, they lack insight.
	However, we need to go further than that. If we allow CTOs to be imposed on every patient who falls into that category, we run a big risk of leaving very wide scope for these powers to be used on people who will derive no benefit from them. There is simply no evidence that, for the majority of patients, coercion in the community works better than an informal regime of community supervision and care. If coercion is used, it must be justifiable.
	For that reason, I have also argued under the amendments that we should seek to restrict the application of CTOs to a relatively narrow group, commonly referred to as revolving-door patients. They are defined by a three-pronged criterion. The first prong is that, on at least one occasion for the current admission under Section 3, the person has refused to accept medical treatment for a mental disorder. The second is that, when appropriate medical treatment has been refused in the past, there has been a significant relapse in his condition justifying compulsory admission to hospital. The third is that, when the person was admitted compulsorily, medical treatment resulted in an improvement in his condition or prevented its deterioration.
	The conditions therefore link the previous refusal of treatment which results in admission with the proven benefit to the patient from the treatment proposed. They then require a relapse to have occurred because of the failure to continue with the medication. Furthermore, the doctor must be clear that the patient is unlikely to continue with the medication without an order. In that way, the legislation will make clear to professionals that the key criteria are: previous relapse, proven therapeutic benefit from treatment and the need—the need—for compulsion.
	The amendment also stipulates that any decision to place a patient on a CTO must involve a medical practitioner. That is because only a medical practitioner can take what are essentially medical decisions—what is the person's mental disorder, how severe it is, how likely it is that the patient will comply with medication, the risk of relapse and so on.
	I do not expect the Minister to change his position on the issue. He has previously resisted any narrowing-down of the criteria for CTOs. We are therefore likely to remain as far apart at the end of this debate as we were at the beginning. That is not a happy state of affairs, but it does not detract from my belief that the amendments represent the right way to proceed, for all the reasons that I have given. I therefore beg to move.

Lord Hunt of Kings Heath: My Lords, obviously these amendments reflect concerns raised in Committee and at Second Reading. The short-term phrase "psychiatric ASBOs" has been used, which we refute. I have concerns about the impact that the amendments would have and want to make it clear that the conditions attached to a community treatment order set a framework for the patient's life in the community. One is not being defensive about this—that is what they are there to do. They make clear what the patient needs to do or not in order to manage his or her mental disorder and to remain stable.
	As noble Lords have suggested, they will be greatly dependent on the professional views of the responsible clinician and the improved mental health practitioner because the conditions must relate to the patient's mental disorder and its management. They must also be acceptable—even if not agreeable—to the patient at the outset. Inevitably, the establishment of the community treatment order will take place after discussion between the patient concerned and the clinician. It is hardly likely to work if the patient is not in a position to take advantage of the community treatment order. If the patient does not agree at least to try to keep to the conditions, what are the chances that supervised community treatment would succeed in the first place?
	As set out, the conditions say that they may be specified. They are merely examples, which will not be appropriate for every case. They are not, with the exception of,
	"a condition that the patient make himself available for examination",
	enforceable. That is not their purpose. We do not propose to recall a patient to hospital merely because he has failed to comply with a condition. Of course, a failure to comply is a signal that something may be going wrong and, depending on the patient's medical condition, recall to hospital may be necessary, but that will depend on the patient's individual circumstances and is not automatic.
	I stress that, just as the conditions in general are not mandatory, the fifth condition is likely to be appropriate for only a minority of patients. It is there for consideration where it is directly relevant to the patient's mental disorder and will contribute to the success of the patient's community treatment. If abstaining from a particular kind of conduct would help a patient to remain stable and if making it a condition of a community treatment order makes that abstention more achievable, the patient and others will benefit. It would be unacceptable to impose such a condition for any other reason, which will be made clear in the code of practice. Two professionals will be involved when a community treatment order is made; namely, the responsible clinician and the approved mental health practitioner, who must both agree to all the conditions before they can be set. That should surely ensure that there will not be arbitrary conditions imposed which cannot be justified.
	I was asked about examples: in Committee, I quoted an example in which a patient was thought to be illegally taking drugs or consuming alcohol to adverse limits. That could impact on the overall treatment and condition of the patient and, in certain circumstances, it may be appropriate to lay such a condition. If noble Lords accept that, I know that they would then wish to bring the tribunal into play. We do not agree that that is the way forward. The tribunal of course is an independent judicial body, which considers the justification for a person's continuing detention, guardianship or compulsory treatment order under the Act. But referring the issue to a tribunal would be to ask the tribunal to substitute its judgment about the best way to treat a patient for that of the professional, or professionals, responsible. We do not agree that that is a relevant decision for the tribunal.
	It is interesting that the amendment does not propose that the tribunal set new conditions to substitute for those that the responsible clinician has sought to place in the case of a particular patient. We also think that these amendments might impose extra and unnecessary burdens on the tribunal, and extra bureaucracy on the tribunal and the responsible clinician. I stress again that, ultimately, the conditions laid out in new Section 17B "may" be specified, save for the condition,
	"that the patient make himself available for examination".
	A failure to observe one of those conditions would not lead to the—

Lord Hunt of Kings Heath: My Lords, these are all hypothetical examples, but my assumption in that circumstance would be that discussion would have taken place between the patient and the clinical team, including the responsible clinician and the approved mental health practitioner. If it becomes clear that the patient would find that unacceptable and is unlikely to oblige by it, that would call into question the decision that a community treatment order would be suitable in that patient's concern. That is the best answer I can give the noble Lord on that. We do not think that the kind of formality that is being proposed here, with the involvement of the tribunal, is the way forward. We believe that the way in which the provision is set out, whereby conditions may be satisfied, is a proportionate approach. I hope that the noble Earl on that basis will consider withdrawing his amendment.

Earl Howe: My Lords, my noble friend Lady Carnegie, who unfortunately cannot be here, has asked me to express her thanks to the Minister for the letter that she kindly wrote on 11 January in response to a point made on these issues by my noble friend on 10 January.
	My noble friend has, however, asked me to put a question. Let us suppose that a patient is detained north of the Border under Scottish law and a proposal is made for that patient to be transferred nearer to his or her family south of the Border. My noble friend's fear is that, unless the basis on which the patient is detained in Scotland accords with English law, it will not be possible to transfer that patient because, were they to be transferred south of the Border, they would have to be released, which would not of course be satisfactory. Does not a practical problem arise out of the disparity between Scottish law and the Bill?

Lord Greaves: rose to ask Her Majesty's Government what provision they will make for the teaching of English for speakers of other languages in England in the next academic year.
	My Lords, this debate is about the provision of English for speakers of other languages (ESOL) in the financial year from this summer. I should declare the interest that my wife is an ESOL teacher.
	This debate is timely; there will be an important lobby on Wednesday, which has been organised by the University and College Union and many other bodies on behalf of the "Save ESOL" campaign. I pay tribute to those who organised this campaign and the many people around the country who expressed considerable concern about the Government's proposals. I thank those noble Lords who want to speak in this short debate. I will listen with great interest to the Minister's reply.
	This is a many-faceted and complex issue. I shall put my own slant on it based on the area that I know best: the Pendle and Burnley area in east Lancashire. What is proposed? The Learning and Skills Council, with the Government's support, proposes to restrict access to free ESOL classes from this summer. The suggestion is that, apart from those who will be excused fees, people should pay 30 per cent of fees this year, rising to 50 per cent in 2010. ESOL classes lead to examinations under the Skills for Life programme at five different levels: the entry level, E1, which is for beginners; E2; E3, which is the benchmark for the citizenship test; and levels one and two, at which stage one might be able to take GCSEs. They are about speaking, listening, reading and writing; in other words, they are about basic language skills, which are the key to so many things that make a full life possible, and which the Government say they believe in.
	What are the Government's beliefs in this regard? They have a belief in citizenship: it is very important to be a full and active citizen in this country and for people to be able to communicate, and that means fluency in English. They believe in the integration of individuals in the communities in which they live and work and in the integration of communities. Five or six years ago, after the disturbances in some northern cities, there was much talk about parallel communities. We had the Cantle report, the Ouseley report and the report from the Burnley taskforce and the noble Lord, Lord Clarke of Hampstead. The underlying tale in the reports was of the dangers of allowing communities to develop, live and exist separately from the wider community.
	In the Pendle and Burnley area, we have a large south Asian community; it is a very traditional community in many ways but it has a great deal to offer. If left without any positive action, it is likely to suffer from the parallel communities problem. Along with those aims and objectives, there is the overriding aim of social cohesion. All those are fundamentally linked to the acquisition of language skills.
	Who will miss out under the Government's proposals? It will vary a lot in different parts of the country. My understanding is that Nelson and Colne College, in the area where I live, is planning for a 50 per cent cut in ESOL numbers next year. Low-paid workers will miss out. They may be migrant workers or members of ethnic-minority communities on the minimum wage or below—plenty of people are paid less than the minimum wage—or part-time workers, who may be paid the minimum hourly wage but have a take-home pay each week that is a lot less.
	The second group of those who will miss out, on which I want to concentrate, is non-employed people—people without jobs who are not unemployed. Many are women who used to be called housewives; nowadays a more politically correct description appears to be "carers in the home". This involves women who work in the home and keep the family and the home going but who do not have a job—they have never had them—and are therefore not entitled to benefits. There are also older men who may have come to this country 30 or 40 years ago to work night shifts in the mills. Those nightshift workers were almost all Asian and did not need English to work. They are now cut off from proper participation in the wider society because of their lack of English. There are also asylum seekers, whom my noble friend Lord Avebury will discuss. Our experience in Nelson is that the ability of asylum seekers to go to ESOL classes from the moment they arrived was a very important part of encouraging and enabling them to live in the local community.
	I want to talk in particular about women. In many ways this is a feminist issue. The Nelson-Colne experience in the past few years is that an increasing number of women of all ages have attended ESOL classes. Some of them are young marrieds, fresh over from the Indian subcontinent; others are mothers who have been here for 30 years, have never found the opportunity or necessity to learn English but have now plucked up the courage to go to ESOL classes. Unfortunately, a traditional aspect in south Asian communities in such areas is that, if those women have to pay, they must get funding from the rest of the family because in many cases they have no money of their own. Given the choice of sending young or older women, or young men—who may have come from south Asia and lack English but who need that ability to get a job—they will choose the young men. Many of these women have been very brave: they have overcome the great reluctance—and, in some cases, opposition—of many of the men folk in their families to go to these classes. The future is bleak for that group.
	I want to refer to two initiatives among many in my part of the world. The Briefield Women's Group, run by Councillor Naseem Shabnam, a colleague of mine, is a multicultural group half of whose members are white and the other half Asian. It is a real breakthrough. It is a local campaigning and social group in the small town of Briefield.
	In Nelson, there is a very exciting regeneration project called the Whitefield Regeneration Partnership. It is regenerating an area of rundown and old terraced houses, many of which are empty, in a heritage-based way in a mainly Asian area. It is innovative and exciting and it will be tremendous. Lesley Chisnell-Helm, the secretary of the Whitefield Community Forum, which is the residents' group, has recently been organising meetings of Asian mothers from the local school and playgroup. These people are excited and have very strong ideas, which are not necessarily the same as those of the men folk from those families. Those are just two groups among many where women are beginning to take part in the community. They are beginning to break down the barriers not just between the communities but within their own community. However, they need language skills to do that and, without such skills, this kind of initiative is impossible.
	Some people referred to language-isolated communities. There are certainly many language-isolated households where the common language is not English and where the television is often tuned to a satellite station that does not broadcast in English. It is vital that the women in these households learn English. It is linked to many of the Government's general objectives and to the education of very young children. If more English were spoken, including by mothers, these children would not start with the handicaps that they have when they go to school, and indeed they could take part in the education of the older children.
	Learning English is also important for children's health and well-being, the regeneration of areas, as I have suggested, integration and cohesion, and friendships across the cultural divide. It is essential that individual friendships develop between people in different communities but, if there is no common language, that will be impossible.
	I want to finish by asking the Government some questions. First, have they carried out an assessment of the likely fee levels, and how much are they likely to vary from college to college? Is £300 for 30 weeks, at four hours a week, the kind of level that people might be talking about? Secondly, what proportion of existing students is likely to get the full fee remission? It must be possible to know that because we know who the existing students are. Thirdly, what research have the Government done on the elasticity of demand following the introduction of ESOL fees? In other words, what do they believe the drop-out rate will be? Fourthly, what research have they undertaken into the willingness of employers of migrant workers to pay fees for ESOL classes? Finally, what is the expected increase in class sizes under the new system, which I gather will take place, and what effect do the Government think it will have on the quality of provision?
	I want to read to noble Lords an examination answer from an E3 student in response to being asked to:
	"Write an email to a friend who is coming to England and wants advice on learning English".
	The answer read:
	"Hello ... Don't worry. I started to learn English when I was 10 years old from my school. When I had finished my school I only remembered one poetry.
	ABCDEFG John is hiding far from meLooking here, looking there,I can't see him anywhereIs hiding
	When I came to England, I went straight to the learning centre. For myself was very easy to learn words, but difficult grammar.
	Now I want to write, what Walt Whitman (USA) told about language:
	'Language is not an abstract construction of the learned or of dictionary-makers, but is something arising out of the work, needs, ties, joys, tastes of long generations of humanity, and has its bases broad and low, close to the ground'".
	That really describes the present system of ESOL provision. It is broad and low; it is close to the ground. The student ended by saying, "Take care". I ask the Government to take a little more care with the ESOL provision in this country.

Baroness Maddock: My Lords, I hope my intervention will be brief. It is based on my experiences, first, as a native English speaker; secondly, as someone who, many years ago, taught English as a second language to multi-national groups; and, thirdly, as someone who arrived in a country whose language I could not speak. Speakers before me have indicated how important verbal communication is: if one is to interact with one's fellow human beings, it is essential; it is vital if one is to feel part of a community; and it is vital if one is to understand the society in which one lives, its governance, how to access services and how to be part of the community.
	Earlier today, I was struck by the fact that in much of what one is required to do in this country one has to access the internet, which is all in English. As English speakers, we have had it very easy. Many people in the world speak English, but most native English speakers have not had to grapple with not understanding what is going on around them. I wonder whether that is why we are rather poor at understanding the importance of people being able to speak our language when they come to live here.
	More than 35 years ago, I went to live in Sweden. I did not know any Swedish and I thought I was pretty lousy at languages. I had passed O-level French, but my ability to speak it was fairly limited. What is it like to arrive in a new environment? It is very disconcerting because there is a lot of noise around you and you cannot even understand where words start and finish. That starts to improve that after a while, but it is very isolating and quite frightening. I remember being on the underground in Stockholm and listening to the noises and not knowing what they mean. I also spent a little time living in Germany and know that Germanic rules are very important. In Sweden and in Germany, if one does not understand the language it can be quite disconcerting.
	English people are very bad at understanding that. In most of the countries that we visit, people understand English. In Sweden, if I really needed to get to grips with something, wherever I went, someone was able to understand English. In my early days in Sweden, I can still remember trying to find something in their equivalent of Woolworths and tentatively asking the assistant in English, to which she said, "It's just in the second aisle on the left". I remember thinking, "Gosh, would that have happened in Woolworths in England?".
	I started to teach English as a second language in that environment. In Sweden, then, as now, one had free tuition in their language. Every week I used to go to the classes, although everyone else went twice a week—I could go only once a week because I was teaching English. That was incredibly frustrating. Having been there for a while, my present husband was getting rather good at Swedish, whereas I was pretty awful. Eventually, I had some time off and so I attended a course for 20 days—every week-day for a month. Swedish courses were free if you were a foreigner in Sweden and, although I started off very haltingly, by the end I was relatively fluent in everyday Swedish.
	Those experiences, including being a teacher, have led me to believe that if one wants to get the best value out of teaching people English the courses need to be intensive. On an intensive course, one speaks the language every day and does not lose what one learnt the day before. If one attends a course once a week and then returns to one's own environment and speaks one's own language for the rest of the week, it does not work so well.
	My message to the Government—my noble friends know about the day-to-day problems in England today and I am not involved with teaching English as a second language any more—is that it is really important for people to be part of the community and the culture and to be able to speak the language. If one is serious about it, intensive courses are by far the best and charging people is not the way to go. In Scandinavia and in other parts of Europe, where not many foreign people speak their language, they understand what it is like not to understand the language of the community in which they live and they are far more willing to provide free language teaching. To charge people is a very backward step and one will achieve far better value for money if one provides people with an opportunity to attend intensive courses in English rather than courses that are spread out over a longer period.
	I congratulate my noble friend on initiating the debate. It is very important. Quite frankly, I was dismayed when I heard on the news that the Government thought that it was acceptable to start charging people to learn English, when common sense tells us that this is a key point if we are to try to make our communities cohesive.

Baroness Thomas of Winchester: My Lords, I, too, congratulate my noble friend Lord Greaves on introducing this important debate on the vexed question of the future funding of ESOL classes. It is essential that classes up to the basic level should remain free. It is surely to the advantage of everyone in the United Kingdom that as many of our population as possible speak English; it is in the interests of all aspects of social inclusion and cohesion, in the interests of employers and of the whole workforce, and not least the interests of health and safety. The Government recognise that, which is presumably why, in 2001, they tripled the funding for the Skills for Life programme of which ESOL is a part. ESOL classes have been a runaway success and are now hopelessly oversubscribed in many parts of the country, with up to 1,400 on the waiting list for colleges in London.
	In an exchange at Question Time on 1 November, the Minister was emphatic that the charge being made for ESOL classes from August this year, except for those on benefits, will not be prohibitive, but many in the area disagree. A fee of £300 for a six-hours-a-week course is one estimate, as my noble friend said. The timing of this change could not be worse. Only a few weeks ago the Minister for Employment and Welfare Reform said that at least 40,000 people do not have the language skills to get a job and that state benefits might be withheld from those who do not make an effort to learn English. Just two months ago the Leitch report emphasised the importance of up-skilling the workforce. The report says:
	"More flexible migration flows increase the need to ensure that migrant workers are fully integrated into the existing labour force and that they are at their most productive. However, for many migrants integration is made more difficult by language barriers".
	There is a huge reservoir of valuable skills among those attending ESOL classes, skills that we badly need in this country.
	Also in the news recently has been a huge demand for translation services far greater than in any other EU country. I have recently learnt that the professional translation service is in despair at the haphazard way in which translating now happens, with non-accredited translators regularly being used by the police and healthcare providers in many parts of the country. That is a debate for another day but it is yet more evidence that making the teaching of basic English widely and freely available throughout the country would be cost-effective because translation services are so expensive. As far as employers are concerned, many of those running both large and medium-sized businesses are doing their bit by laying on English classes for their non-English speaking employees. It is unrealistic to expect a small employer with just two or three employees to do this in a competitive environment where survival is all-important.
	One consequence of charging for ESOL classes would be a big increase in administrative costs. How will colleges cope when even more of their clients ask for help in claiming benefits to which they may be entitled in order to access free classes? The benefits field is not simple, even to those who speak perfect English. Either the college will have to increase its administrative staff, or it may simply have to turn away those who cannot afford to pay.
	In preparing for this debate, I contacted one rural college in the west Midlands and one London college. In the rural area, classes were attended by the large number of seasonal agricultural workers from the new EU accession countries who had decided to settle there. Classes there are being partly funded by the European Social Fund programme for pre-employment training. ESOL classes will therefore remain free until May 2008, and the staff are extremely concerned about what will happen after that. In that part of the world, as elsewhere, there are also informal classes arranged through the churches in the area, often taught by retired teachers, to meet the high demand.
	At the London college, the clientele was, interestingly, 75 per cent middle-aged women, including a high number of Kosovans and Sri Lankans as well as eastern Europeans. The college made the point that, last year, funding was cut for the pre-entry and assessment courses assisting those who are often illiterate in their own language, let alone ours, but who are having to be taught with those on level 2; that is, highly educated and articulate people who want to improve their English. Having the two groups taught together has made life difficult for everyone.
	Finally, although it has already been mentioned, I must again make the point that there are patriarchal elements within some minority communities that use women's inability to understand the English language as a means of keeping them dependent, isolated from wider British culture and oppressed. The introduction of charges for courses makes it easier for the men in these communities to deny economically inactive women the opportunity of enrolling on courses. With free classes, women are currently better able to resist pressure that their needs should not come before those of their husband, children and extended family.
	It is surely a false economy at this stage in the life of our country—when the economy is doing well out of migrant workers on one hand and the integration of so many culturally diverse groups is at the top of the agenda on the other—for the Government to cheese-pare by charging for the most basic skill of all: speaking our language. I urge them to think again.

Lord Adonis: My Lords, the House is grateful to the noble Lord, Lord Greaves, for raising the important issue of teaching English to speakers of other languages and for the perspective that he brings to the subject from his experience and that of his wife in Pendle and Burnley. As the noble Lord said, nothing is more important to our country than that all our citizens should have effective English-language skills. Without that, we will not create a fair or an integrated society, least of all in an age of substantial migration.
	My honourable friend Bill Rammell, the Minister of State for Lifelong Learning, Further and Higher Education, will be paying close attention to this debate, and I will draw to his attention all the points that have been raised by noble Lords. Indeed, he is speaking at the rally mentioned by the noble Lord. Perhaps by saying that, I will encourage even more people to attend. My honourable friend takes his responsibilities in this area very seriously and intends to be present. I am also grateful to the noble Baroness, Lady Maddock, for addressing us in English, not Swedish. She would have made her point very effectively if she had tried us in another language, but she enabled me to follow closely what she was saying.
	The straight factual answer to the question posed by the noble Lord, Lord Greaves, is that the Government, through the Learning and Skills Council, will make available about £300 million for colleges and other organisations to provide for the teaching of English to speakers of other languages in the next academic year. I cannot be precise about the sum because the final figure will depend on local planning within the overall adult learning budget of the Learning and Skills Council, which will be £2.841 billion for the financial year 2007-08. The figure of about £300 million is about the same as indicative funding available for ESOL this year and last year—there have been no cuts in the budgets—and it represents a threefold increase on the funding available as recently as the financial year 2000-01, when it stood at £103 million. The Government's bona fides in supporting this important area of teaching are strong, and it is not the case that there are cuts in the national budget.
	The concerns in this debate are whether the provision is sufficient and what more we could and should be doing, so I shall address those wider issues. Since 2001, state funding for ESOL courses has tripled, as has the number of people taking ESOL courses. In that time, we have invested more than £3 billion in the national Skills for Life strategy, £1 billion of which has gone on ESOL programmes, thereby helping almost 2 million learners to improve their confidence as English-language speakers. As demand rises further, our aims are to ensure that public funding, which is obviously constrained, is targeted at those with the greatest need and to improve course availability for all those who need ESOL provision.
	As the noble Lord, Lord Greaves, rightly said, the demand for ESOL learning has never been greater because significant demographic changes have accompanied our sustained economic growth. Only last month, the Audit Commission published a detailed report, Crossing Borders, revealing the pace at which legal economic migrants have entered the UK intent on securing work and taking advantage of all that this country has to offer. The noble Baroness, Lady Verma, particularly stressed the pressure being brought in this area by people from the A8 accession states. She is right to highlight that issue, but I should stress that they account for less than 12 per cent of total ESOL demand, so it needs to be kept in proportion, but this is clearly an issue that we face.
	Migrant workers from the new EU member states make a significant and welcome contribution to our economy, but their demand for language skills has presented fresh challenges for ESOL providers. Rising demand for places on some courses is such that in London waiting times can be as long as two years, while elsewhere 18-month delays are not uncommon.
	Moreover, as a recent report by the National Institute of Adult Continuing Education acknowledged, we are still not reaching all the priority learners who face the greatest barriers to employability and social integration. Among our priority groups, for example, are the group mentioned by the noble Lord, Lord Greaves—Bangladeshi women, some of whom face tremendous obstacles, including the risk of abuse or being ostracised for venturing out of their homes to attend English classes. It is essential that FE colleges and other providers are encouraged to reach such groups as a top priority for government-funded courses within what is an inevitably constrained budget, despite the threefold increase that has taken place during the past six years.
	That is why, together with the Learning and Skills Council, we have reviewed ESOL arrangements for next year. Although we expect funding to continue at broadly the same level as this year, we have made two changes: first, removing eligibility for ESOL places from asylum seekers who will not have the opportunity to settle in the UK; and, secondly, removing universal fee remission irrespective of income.
	Let me take the two issues in turn. First, in respect of asylum seekers, about whom the noble Lord, Lord Avebury, spoke passionately, I have of course noted his views. As he knows, the change has been made in light of improvements to the time that the Home Office takes to resolve asylum claims. The great majority of initial decisions are now made within two months. With a high proportion of asylum seekers ineligible to remain in the UK, the Government believe that ESOL funding is rightly targeted at those learners either granted refugee status or already living in settled communities.
	The noble Lord raised the issue of those asylum seekers who are here for longer waiting for their claims to be determined. I can tell him—this deals with a number of other points raised—that we will shortly publish a race equality impact assessment of the effect of the changes, which follows a good deal of consultation with interested parties. We will consider issues raised by the assessment. I can tell the noble Lord that that will include the issue of those whose claims take longer to assess.
	In respect of the second change—the withdrawal of automatic fee remission from those who can afford to pay for ESOL courses—let me be frank. We see this as a hard choice but a justifiable one, given the pressures on the ESOL budget and the imperative to focus it on priority groups. On low-waged groups who may find it hard to demonstrate lower income under existing tests, again, I can say that we are considering the matter further in the light of the race equality impact assessment.
	However, we believe it reasonable to expect those individuals who can afford it to make a contribution to the cost of their learning. That should not be a prohibitive sum. The Government's contribution will remain substantial, covering 62.5 per cent of course fees. Those eligible for completely free courses will include the unemployed, the unwaged or the very low paid, learners receiving jobseeker's allowance, those on an income-related benefit, or those who claim the higher rates of working tax credit. As I said, the contributions sought from learners—even those who are not in those priority groups—will be a maximum of 37.5 per cent in the next financial year. The noble Lord, Lord Greaves, asked whether the typical course fee for a four-hour-per-week course over 30 weeks would be about £300. I can tell him that that will be the case. Typically, it will be £300 for 120 guided learning hours, but I should stress that that means that the Government will continue to contribute substantially. For the same course, the Government will pay almost £900 as our contribution to the cost of the course.
	The noble Lord asked about the proportion of existing students who will continue to receive fee remission. We estimate that about 70 per cent of students will continue to receive full fee remission and therefore free ESOL courses. He asked about our estimate of the drop-out rate. I can tell him that the Learning and Skills Council does not anticipate that that will increase due to the changes because, as I said, 70 per cent will continue to get free ESOL courses and priority groups—those most in danger of dropping out—will be fully covered by the fee remission. Also, we do not expect class sizes to rise, not least because they are so large already, because demand is so great, that we do not expect that the providers would want to increase their size, even if they could.
	I state clearly that responsibilities in this area do not reside with the Government alone. Employers and recruitment agencies, many of which recruit in large numbers from overseas, have a responsibility to consider the language needs of prospective employees as part of their recruitment costs and planning. Noble Lords mentioned the report last week of the Commission on Integration and Cohesion. The report stressed the role that employers should be playing in ensuring effective ESOL tuition for their employees. Paragraph 37 states:
	"Respondents have also identified the key role that employers can play in providing English-language classes in the workplace, helping new staff to integrate and, in some cases, sharing data with other local partners about population change".
	Employers have clear responsibilities in this area, and I am glad to say that some companies have already developed their own training programmes for staff, which have proved to be highly cost-effective. For example, the bus company First Bus, which was the Skills for Life award winner last year, has already hired more than 1,100 drivers from eastern Europe. The company assesses their language skills and provides training before they arrive in the UK, which the report by the Commission on Integration and Cohesion also mentions. The investment by First Bus in this approach, which includes its own dedicated language school, stands at around £1 million. As a result, the turnover rate among its staff of drivers has dropped considerably.
	It is obviously right, however, that lower-income adults should receive priority for fully subsidised courses. As I have stressed, this will continue as of right. The Government appreciate that such training for these individuals is a lifeline, particularly for those who are out of work, as it prepares them to re-enter the job market with extra skills and increased self-confidence. In a survey conducted by the Department for Work and Pensions, a significant proportion of respondents from ethnic minority backgrounds cited poor language skills as a key impediment to employment.
	Furthermore, from April, Jobcentre Plus advisers have been instructed to raise the issue of language learning with any jobseekers who are clearly struggling to make themselves understood. Advisers will seek to agree a programme of action with these individuals so that any language problems are effectively addressed. In addition, we are developing, with the support of the Learning and Skills Council, a new £23 million basic skills and employability programme for Jobcentre Plus clients, which includes support for ESOL learners.
	We regard this issue as immensely important. I am sorry that I have not been able to respond to all the points that have been made, but I will correspond with noble Lords further to take up points that I have not been able to address tonight. I thank the noble Lord, Lord Greaves, for raising this important issue this evening.

Lord Patel of Blackburn: My Lords, Amendments Nos. 56A and 58A relate to the authority for treating patients who are made subject to community treatment orders or returned to hospital under such an order. They would replace Clauses 28 and 29, which establish the Government's proposals on these matters. My main concern about those proposals is illustrated by the professional slang that has started to be used to refer to second-opinion appointed doctors—commonly known as SOADs—in the context of their proposed role in relation to community patients. The new term is "super-SOADs", from which we can infer that we are talking about a SOAD with special powers. The special powers in question are indeed remarkable, and include the ability to see into the future.
	Under the Bill, at some point during an initial period of at least one month, a community patient will receive a visit from a SOAD. The SOAD will examine the patient and authorise whatever treatment he or she thinks is appropriate at the time according to criteria set out in the Act, but he will also be able to anticipate and authorise the treatments to be imposed on the patient should he or she be recalled to hospital. This, I suggest, is where the Bill requires a SOAD to be not only a psychiatrist but also a person with paranormal powers.
	In short, it anticipates that a SOAD, whose role should be to safeguard against unnecessary or unsafe compulsory treatment, will authorise the forced application of medication in circumstances that he or she cannot foresee at some unpredictable point in the future. The SOAD can have no way of anticipating the circumstances whereby a community patient might be recalled to hospital or what physical or indeed mental condition that patient would be in upon such a recall. A patient who has developed dangerous and possibly irreversible side-effects might have them worsened by the further imposition of medication on the authority of the SOAD. A patient with a heart condition might be killed by the imposition of medication authorised in good faith by the SOAD. Alternatively, the patient may have become pregnant, in which case some medications might be dangerous to her or her unborn child.
	The Minister may argue that I am ignoring the obvious fact that the responsible clinician or whoever is involved in actually giving the treatment to the recalled patient will of course have a duty of care and will not endanger their health or life recklessly in these ways. But if the only safeguard against a SOAD's authorisation being used recklessly in a context other than that in which it was given is the professional judgment of the treating doctor, or even nurse, we have negated the point of the SOAD role. It is important to preserve the role of the SOAD in considering what treatment should be given on the basis of the actual presentation of the patient at the time of their examination. This is the protection that SOADs can offer patients. The Minister may also argue that SOADs already authorise some treatments in advance of their being given, which of course is true, particularly with medication that is authorised on a 'prn' or as-required basis; but they do so on the basis of the patient's presentation and situation at the time of their visit, having examined the patient and consulted two other members of staff who have professional involvement with the patient's care. The SOAD is not acting as if he or she can predict the future.
	I should make it clear that I have an interest as chairman of the Mental Health Act Commission, which is responsible for the administration of second opinions. One of the commission's roles is to appoint and train SOADs, and this means that it must provide advice on second-opinion procedure. The Mental Health Act Commission will be likely to advise SOADs to be extremely cautious when considering whether or not to authorise treatments to be given in an unforeseeable situation at an unidentified point in the future. Indeed, even putting the issue in this way makes me wonder whether the discretion that the Bill allows SOADs in this respect will actually be taken up by this body of responsible psychiatrists. I have to say that I hope it will not.
	The Bill's proposals for SOADs raise another ethical issue. According to the Bill and the draft code of practice, a SOAD who certifies that a community patient consents to treatment would also be enabled to certify what treatments can be imposed on the patient if he or she withdraws consent and is recalled to hospital. I realise that the possibility of coercion hangs over the heads of many psychiatric patients, but this truly is a sword of Damocles. At the very least it would appear to breach the principle underlying true consent as set out in the Mental Health Act code of practice, which at paragraph 15.13 states:
	"Permission given under any unfair or undue pressure is not 'consent'".
	This brings me to my alternative model, set out in these amendments. The key difference between my model and the Bill is that any certification of the treatment of a community patient cannot authorise treatment upon recall. This means that the forcible imposition of treatment to a recalled community patient would find authority only in the urgent treatment provisions set out in Section 62 unless and until a further second opinion is requested to consider treatment in the new context of detention.
	The amendment would not extend the three-month rule. Under the Bill, the requirement for a certificate authorising treatment takes effect only after the CTO has been in place for at least one month, and may be longer. A patient discharged to a CTO during his three-month period as an in-patient would have to wait until all of the unspent part of the three months had run its course before having the safeguard of a second opinion. Indeed, when an in-patient's three-month period is but a distant memory, if that patient is discharged on to a CTO he or she will be subject to a new one-month period where the safeguards over his or her treatment as an in-patient will be suspended. I think patients will perceive that to be simply unjust.
	My alternative proposal, where the three-month period still has some time left to run when the CTO is made, is to require certification no later than one month from the start of that order. Therefore, if the three-month period had expired within the first month, it would not be extended at all. If it were extended for more than one month from the start of the CTO, it would expire exactly one month from the start of that order. For in-patients whose three-month period has expired at the point when a community treatment order is made, I would require certification from the start of the order. Let us remember that drug treatment in the community is inherently less safe than such treatment under 24-hour medical care in hospital. We should be increasing the safeguards for community patients, not lessening them.
	To enable the certification from the start of CTOs, part of the preparation for discharging a patient on to a CTO would be for incapable patients to be visited by a SOAD, and for a capable patient to have a consent discussion with a clinician responsible for the treatment. It would be permissible to complete certificates prior to the patient's discharge that would only take effect once they become a community patient. There is a precedent for that in the fact that all detained patients who are currently coming to the end of their three-month period will have Section 58 certificates completed for them, with such certificates taking effect only when the period has actually expired.
	Such an approach seems to be both more of a safeguard for patients and more practical for the administration of the SOAD system. One of the great unknowns in the Government's proposals is how the second-opinion system might work with community-based patients. My proposals would allow for many SOAD visits in relation to the new powers to be undertaken before the patient ceases to be resident in hospital. At the very least, such a system would ensure that we knew where the patients were at the time when they were due to be examined by a SOAD. I have some concerns that under the Government's proposals a great many clinicians would be faced with the dilemma of whether to recall a patient to hospital simply because they do not attend appointments to meet a SOAD.
	Nothing in my proposed arrangements contradicts my objections to SOADs anticipating patients recalling their authorisations. Certification, as a part of the discharge package, would of course take place where a patient's situation and mental or physical state were quite apparent to the certifying doctor.
	My amendment would reduce the complexity of the Bill; it uses the existing framework of Section 58 as its basis. We have heard from the Minister many times during our debates about the limitations of an amending Bill, and that we are not writing new mental health legislation from scratch. In that spirit, I offer this amendment on the basis that it makes only the most necessary changes to the current statute to set out the effects of community treatment orders under Part 4 of the 1983 Act.
	My amendments, in contrast to the Bill's provisions, would result in simpler and more practical arrangements for authorising treatment in these circumstances. Moreover, they would preserve the role of the SOAD, they would be safer for patients and more acceptable in ethical terms for the professionals who operate the Act. I hope the Minister will give them full consideration.

Lord Patel of Bradford: had given notice of her intention to move Amendment No. 56A:
	Clause 28 , leave out Clause 28 and insert the following new Clause—
	"28 Authority to treat community patients
	(1) In section 58(3) of the 1983 Act, after "patient" insert "who is liable to be detained under this Act".
	(2) After section 58(3) of the 1983 Act, insert—
	"(3A) Subject to section 62A below, a community patient who has not been recalled to hospital shall not be given any form of treatment to which this section applies unless—
	(a) he has consented to that treatment and either the approved clinician in charge of that treatment or a registered medical practitioner appointed for the purposes of this Part of this Act has certified in writing that the patient is capable of understanding its nature, purpose and likely effect and has consented to it; or (b) a registered medical practitioner appointed as aforesaid (not being the approved clinician in charge of the treatment in question) has certified in writing that— (i) the patient is not capable of understanding the nature, purpose or likely effects of that treatment; (ii) he has either no reason to believe that the patient objects to being given the treatment, or he does have reason to believe that patient so objects, but it is not necessary to use force against the patient in order to give the treatment; (iii) he is satisfied that the treatment does not conflict with a valid and applicable advance decision, or a decision made by a donee or deputy or the Court of Protection; and (iv) having regard to the likelihood of its alleviating or preventing a deterioration of his condition, the treatment should be given.
	(3B) Where a patient who has been liable to detention under this Act has been administered medication for a mental disorder to which this section applies for less than three months prior to becoming a community patient, the period mentioned in section 58(1)(b) above shall be read to extend for no longer than one month beginning with the day on which the community treatment order is made.
	(3C) The Secretary of State may by order vary the length of the period mentioned in subsection (3B) above.
	(3D) Certification under subsection (3A) above may take place whilst a patient remains liable to be detained, but will not come into force until the responsible clinician discharges the patient from detention in hospital under the terms of section 17A(1) above."
	(3) After section 58(4) of the 1983 Act insert—
	"(4A) Before giving a certificate under section 58(3A)(b) above, the registered medical practitioner shall consult two other persons, who have been professionally concerned with the patient's treatment, but of those persons—
	(a) at least one shall be a person who is not a registered medical practitioner; and (b) neither shall be the patient's responsible clinician or the approved clinician in charge of the treatment in question."
	(4) In section 61 of the 1983 Act (review of treatment)—
	(a) in subsection (1) for "or 58(3)(b)" substitute ", 58(3)(b) or 58(3A)(b)"; (b) in subsection (1)(a) after "20(3)" insert "20A(4)"; (c) in subsection (3) for "responsible medical officer" substitute "approved clinician in charge of the treatment in question"; (d) in subsection (3), for "or 58(3)(b)" substitute ", 58(3)(b) or 58(3A)(b)".
	(5) In section 64 of the 1983 Act (supplementary provisions for Part IV), after subsection (2) insert—
	"(3) In this Part of this Act, references to "not capable of understanding the nature, purpose and likely effects of treatment" are to be read in accordance with the test established at section 3 of the Mental Capacity Act 2005.
	(4) References to a donee are to a donee of a lasting power of attorney (within the meaning of section 9 of the Mental Capacity Act 2005) created by the patient, where the donee is acting within the scope of his authority and in accordance with that Act.
	(5) References to a deputy are to a deputy appointed for the patient by the Court of Protection under section 16 of the Mental Capacity Act 2005, where the deputy is acting within the scope of his authority and in accordance with that Act.
	(6) Reference to the responsible clinician shall be construed as a reference to the responsible clinician within the meaning of Part 2 of this Act.
	(7) References to a hospital include a registered establishment."
	(6) In section 119 of the 1983 Act (practitioners approved for Part 4 and section 118)—
	(a) in subsection (2)(a) leave out "in a registered establishment" and insert "in a hospital or registered establishment or any community patient in a hospital or establishment of any description or (if access is granted) other place"; (b) in subsection (2)(b) leave out "in that home" and insert "there"; (c) after subsection (2) insert— "(3) In this section, "establishment of any description" shall be construed in accordance with section 4(8) of the Care Standards Act 2000."
	(7) In section 28 (Mental Health Act matters) of the Mental Capacity Act 2005 (c. 9), after subsection (1) insert—
	"(1A) Section 5 does not apply to an act to which section 58(3A) of the Mental Health Act applies.""

Lord Hunt of Kings Heath: My Lords, I am grateful for the noble Baroness's helpful comments. This is clearly a complex area.
	I begin by saying that I should be very happy to institute discussions between now and further stages of the Bill. I give no commitment but it is important that there is an opportunity to discuss a complex area. I am happy to accept the invitation that noble Lords have given to enable that to happen.
	The Family Law Reform Act provided that 16 should be the age at which the consent to treatment should be treated as though that person were an adult and the consent of a person with parental responsibility should not be required. The Mental Capacity Act, as I have already said, also provided that in general none of the measures in it would apply to persons under 16. The position of under-16s is more complex; there is likely to be far more variation. That is why our initial thinking is that guidance is able to go into much greater detail in this difficult area. That is our preference.
	Where the child is Gillick-competent—that is, it is deemed that they understand what they are consenting to and the consequences of that consent—and the child consents, the draft code plainly says that he can be admitted informally on that basis. I reiterate for the noble Earl, Lord Howe, that that is very much a draft code and is work in progress. Comments made during the passage of this Bill will undoubtedly be fed into the code. Where a Gillick-competent child refuses, our guidance will state that it would be unwise to rely on the consent of a person with parental responsibility, and to detain a Gillick-competent child against his wishes might be in breach of Article 5 of the ECHR. The code will suggest that detention under the Mental Health Act should be considered, although again there is the possibility of an application to the court. But, for under-16s, every case will be different and depend on the specific facts of that case. That is why we think that it is right to leave under-16s to the code.
	This is a developing area of law; that is why we think it better to put this guidance in the code. I accept what the noble Earl said about clarity in the law but the problem with the amendment is that it requires children to be treated as adults as a blanket rule; we think that for those under 16 every case will need to be looked at individually and have regard to a range of factors that will be explained in the guidance. For example, where the child is not Gillick-competent to make such a decision, if the decision falls within the zone of parental responsibility, a person with parental responsibility will be able to give consent and the child can be admitted informally on the basis of that consent. Guidance as to what is within what is known as the zone of parental responsibility will be given in the code. Again, this is a developing area, and we think it more helpful to give detailed advice in the code, which can be updated from time to time. It is, however, basically about the kind of decisions that our society thinks it proper for a person with parental responsibility to be able to take.
	Where the child is not Gillick-competent and either it is not considered that the child could be admitted informally on the basis of the consent of a person with parental responsibility, or no person with parental responsibility is prepared to consent, consideration should be given to the use of compulsion or, occasionally, an application to the court. As I said, the Family Law Reform Act sets 16 as the benchmark for a young person to give consent to treatment as though he were an adult. We think that our approach is in line with that. I should be happy to enable further discussions to take place on this important matter but our default position is that, because of the complexity, we think that the code of practice is the best place to deal with it.

Earl Howe: My Lords, I am extremely grateful to the Minister for having tabled the government amendment. It is most welcome and responds to the concerns expressed from around the Chamber in Committee that the law as it stands is inappropriately rigid. A permissive power to move a mentally disordered person from a police cell to another place of safety without necessarily waiting for 72 hours to elapse is a sensible and humane provision. However, perhaps I may bring us back to our Committee debates. I confess to a measure of disappointment that the Government have not felt able to pick up some of the other concerns that I and others raised on that occasion. The amendment in my name grouped here is designed to go somewhat further than Amendment No. 68.
	Everyone agrees that a police cell is not a therapeutic environment for someone who may have reached a mental crisis point and may even be suicidal. It is simply, if you like, an expediency. I do not propose to repeat everything that I said in Committee, but putting someone in a police cell when they are in an excited or depressed state of mind is neither good for the person nor fair on the police. We have to recognise that police cells should be available as a last resort, but that is not what the Act says. It places police cells on an equal footing with other places of safety as though all had equal validity. Amendment No. 69A therefore says that a police cell should be used only if it is impracticable to use a therapeutic environment. It also proposes that the period of 72 hours allowed for in the Act for someone with mental health problems to be detained by the police is too long and that it should be reduced to 24 hours.
	I still think that the case for making this change is extremely strong, and it is supported fully by the Police Federation and the Independent Police Complaints Commission. In fact, new research from the IPCC shows that the average amount of time that those detained under Section 136 are held in custody is 10 hours. The vast majority of detainees—95 per cent, in fact—leave police custody after 18 hours. That suggests very strongly that making an amendment to the Act to reduce the maximum period of police custody to 24 hours would not represent an unduly onerous requirement. Indeed, it is fair to say that it is only the absence of suitably trained specialist staff to carry out assessments that prevents police in some areas of the country discharging mentally disordered detainees even more quickly. With that thought in mind, the amendment would also put in the Act a duty to ensure that, where someone is detained in a cell, he must be assessed by mental health professionals or transferred to a psychiatric hospital within the shortest possible time.
	I realise that the Minister is unlikely to warm to the amendment or at least to the parts of it that do not chime in with Amendment No. 68. In view of the widespread concerns expressed on these issues, both from the police and the mental health community, I ask him whether he will agree once more to take these various points away with him and give them further thought. If he cannot agree to the amendment, it would be extremely welcome if the Minister were able to give a commitment to monitor the use of police cells as places of safety and publish the figures regularly. At least that would help to establish the extent of the problem and the particular areas in which police cells are over-used. At the moment, there are no official national statistics or monitoring of the use of police stations as places of safety.
	I understand that the Police Federation does not believe that that would be an unnecessary administrative burden. Most police authorities already have a computer system that allows them to log in when a patient is brought in under Section 136. However, according to the IPCC research, currently there are wide variations in the way in which that data is recorded, which makes it difficult to establish accurate numbers of people detained in police cells.

Baroness Neuberger: The amendment has been introduced late in the passage of the Bill due to the report of the Joint Committee on Human Rights. Other noble Lords around the House will be quite aware of that.
	The JCHR recommended:
	"We urge the Government to ensure that, whatever method of regulation is adopted, sufficient safeguards are included on the face of the bill to ensure that seclusion is only used when strictly necessary and that individuals subject to it should have access to review at intervals to ensure that it is brought to an end when no longer necessary".
	The amendment deals with seclusion and regulates its use and other methods of managing disturbed behaviour to provide greater safeguards to patients subjected to such interventions. The Joint Committee on Human Rights identified the lack of regulation in the Act as an omission. The House of Lords held, in R (Munjaz) v Mersey Care NHS Trust and Others, concerning the introduction of a written policy governing the seclusion of patients at Ashworth Hospital that diverged considerably from the framework in the code of practice on the frequency of review, that,
	"hospitals are free to depart from the Code if they have a good reason for doing so".
	Given the recommendations of the JCHR and the absence of reassurances about the status of the code of practice, we thought it appropriate to debate the regulations of seclusion even at this stage of the Bill.
	Seclusion is defined in the code of practice on the Mental Health Act 1983 as,
	"the supervised confinement of a patient in a room, which may be locked to protect others from significant harm. Its sole aim is to contain severely disturbed behaviour which is likely to cause harm to others".
	The definition in this amendment is based on that. The code also specifies that:
	"Seclusion should be used ... as a last resort ... for the shortest possible time".
	It,
	"should not be used; as a punishment or threat ... as part of a treatment programme ... because of shortage of staff",
	or,
	"where there is ... risk of suicide or self-harm".
	I think that the Mental Health Act Commission may have proposed a slightly different amendment to guidance on the latter point.
	It may be necessary to have a fuller description in regulations or the code of practice to ensure that all practices that amount to seclusion are indeed covered. In its latest biennial report, the Mental Health Act Commission sets out various terms used to describe a range of practices that still amount to seclusion. These include therapeutic isolation, single-person wards, enforced segregation, and restriction of movement. The quality of care provided under these circumstances can vary widely, from the very good to the dangerously substandard. The Department of Health has also referred to different kinds of nursing and accommodation that is separate from other patients as "alternatives to seclusion". Again, that may undermine regulation of these practices. This amendment deliberately uses the language of managing behaviour to differentiate these interventions from clinical or therapeutic interventions; I cannot state too clearly or strongly that they are not.
	There is some considerable prevalence of seclusion being used in the mental health system. The Mental Health Act Commission's own census found that 3 per cent of all psychiatric in-patients resident on 31 March 2005 had experienced one or more episodes of seclusion in their period of admission or in the previous three months, 112 patients had experienced at least five periods, and 42 at least 10. The maximum number was over 100, and there were particularly high rates for black patients. Here is an issue that ought, yet again, to ring alarm bells with all of us; it seems to be overused for black people and those from minority-ethnic communities. It appears that this could be an area where the use of seclusion—if it is to happen at all—is overly strong with some communities rather than others.
	Over six months in 2004-05, the Mental Health Act Commission collected data on episodes of patients being held in isolation for 48 hours or more. It was notified of 74 episodes in the acute sector and 156 in the medium or high secure sector. Many were for much longer periods, and many were not described as seclusion. The Healthcare Commission's recent audit of psychiatric units found about one-third saying that they used seclusion at some point or other.
	Numerous aspects of seclusion may lead to patients' rights being infringed. The grounds for using seclusion could be punishment rather than treatment. There could be conditions in which people were accommodated without a toilet or any washing facilities—people can be cared for really badly during seclusion—or issues about how seclusion is brought to an end. For instance, there are examples of staff requiring the patient to "show remorse", or all sorts of issues in how complaints about using seclusion are dealt with. All these areas could be addressed by the review and by the visiting requirements envisaged in regulations.
	This amendment simply proposes that the Act sets the scope for regulations with which the use of seclusion, and any other interventions added to the clause, must comply. Those would define: the circumstances in which the measures could be used; reporting requirements; review and scrutiny; visiting issues; and, if there are people who are subject to prolonged or repeated seclusion, making sure that they are visited by an independent person who can protect their rights. These regulations would set limits on the use of seclusion and provide procedural safeguards to check whether people in this extremely powerless set of circumstances were being treated in accordance with the code of practice. As this is such an important and difficult area, we believe that there has to be consultation on any regulations before they are laid.
	Finally, in addition to the recent Joint Committee on Human Rights report, the Joint Committee on the draft Mental Health Bill recommended that the Bill regulate the use of seclusion and mechanical restraint by requiring the same kind of safeguards provided in the current code of practice to ensure that decisions to seclude or restrain are made only when absolutely necessary, are subject to regular monitoring and review, and that the seclusion or restraint is brought to end immediately the intervention is no longer needed for the protection of others. There should be a requirement to report such interventions to the Mental Health Act Commission and, if seclusion or restraint is prolonged, a member of the expert panel should visit the patients. The Government agreed with the Joint Committee on the draft Mental Health Bill about this when that draft Bill was still current and they agreed that similar safeguards should continue in this Bill. They also shared the concerns about prolonged seclusion and restraint and were exploring how best to safeguard patients' interests in the context of the new legislation. According to the Mental Health Act Commission, the Government were considering using the mechanisms then being proposed in the Mental Health Bill that were concerned with medical treatment.
	We were all delighted that the Government were interested in regulating seclusion, but we are concerned that, given the legislation now before us, it no longer appears to be on the Government's agenda and similar mechanisms to those governing treatments are being considered. Seclusion is a means of containing violent behaviour, but it is not a treatment. Confusing the two functions could have the effect of legitimising seclusion for other purposes and weakening any safeguards by giving scope for clinical discretion. We believe that this is a golden opportunity for the Government to fulfil their earlier intention to commit to a form of regulation and to work out, in consultation, the best way of doing it. I beg to move.

Lord Hunt of Kings Heath: My Lords, I am grateful to noble Lords. I certainly do not want to close down the options for discussion and I am sorry if my applause for the code is seen as a mantra. It is important. We have debated—no doubt, later this evening we shall further debate—the code of practice, but the two go very much together. There are very good reasons why some matters are left to the code and are not in legislation or regulations.
	Essentially, we think it unnecessary and undesirably inflexible to regulate seclusion, restraint and other similar interventions in the way proposed by the amendment. It is true that the amendment leaves the details to regulations, which is certainly preferable to trying to codify rules in primary legislation, but we still foresee difficulties finding sufficiently clear definitions for regulations. Such definitions should not, on the one hand, encroach on what may be thought of as routine clinical interventions, rather than crisis responses. On the other hand, I very much agree that we should not encourage people to use less appropriate techniques to avoid the bureaucracy of the regulations—the risk of the perverse incentive—or because what they believe to be the best in the circumstances is not permitted.
	There is genuine concern that we may unwittingly restrict staff to a limited range of techniques that do not sufficiently recognise the huge variety of scenarios that they may face. Any kind of restrictive regulation invariably runs the risk of inhibiting new innovative techniques for managing difficult behaviour.
	We accept that there is variation in the use of seclusion and restraint, not all of which represents genuine differences in need. I have no doubt that there are places where practice can be improved. However, we must be wary of defining what hospital staff may or may not do either as part of routine clinical care or as an immediate response to dangerous situations. It is worth remarking on the issue of violence towards NHS staff. A programme is being broadcast at this very moment about it. We need to recognise the situations in which staff find themselves. We have to pay regard to their interests in these matters.
	Currently we address such issues through guidance to practitioners in the code of practice. The code currently states that hospital managers should have clear written policies on the use of physical and other forms of restraint. Physical restraint should take place only as a last resort, not routinely. Any restraint should also be reasonable in the circumstances, apply the minimum force necessary to prevent harm to the patient or others, be for only as long as necessary and be sensitive to gender and race issues.
	In preparing the draft illustrative code of practice, I have remained very aware of the deliberations in the Joint Committee on Human Rights and our evidence to it, which concluded that the most appropriate approach to this practice issue is to provide for it through guidance in the code of practice. That remains our position. In preparing the draft illustrative code of practice to accompany the Bill, we revisited and updated the guidance on seclusion and constraint. It will be further developed in the new code to be issued for consultation. I understand that the Assembly Government intend to make a similar provision in the code of practice for Wales. The draft illustrative code of practice reflects the NIMHE 2004 guidance, the Mental Health Policy Implementation Guide. It also advises that the NICE guidelines are also adhered to. The NICE guidelines address the management of aggression and violence, including restraint.
	The use of seclusion and restraint is often a clinical judgment. Its use should be informed by detailed professional guidance of the sort to which I have just referred. The code of practice provides that such guidance is brought to the attention of practitioners and service providers. We need to be clear about the observation of the Appellate Committee of this House that the requirement that cogent reasons be shown for any departure from the code sets a high standard that is not easily satisfied. We must be clear about that, although I realise that we will probably discuss this a little later on.
	Section 120 of the Act already enables the Mental Health Act Commission at any reasonable time to visit and interview any detained patient and to inspect any records relating to the detention or treatment of that patient. I know that there are concerns that young men from some black and minority-ethnic groups are over-represented in the use of seclusion and restraint. I understand those concerns: we all have general concerns about how a group of people is treated in the current services. I understand that the 2006 census will show less emphasis in relation to that figure. I must be careful not to speculate, but one can only hope that some of the current publicity and the advice and guidance are beginning to have an impact on service provision and practice activities in the services.
	We will keep the operation of the Act under review, and we will look for comprehensive information on how it is used, which will help us to monitor better what is happening. Again, as I said about places of safety, when the new combined regulator for health and social care is formed, we will consider how information on the use of seclusion may be reported to the new regulator. I do not seek to undermine anything that the noble Baroness and the noble Lord have said about this. We simply think that it is better to deal with this in the code.

Baroness Meacher: My Lords, I am obviously disappointed at the Minister's response. I hope that we can discuss negotiating with the Home Office to improve responsibility for the police arriving at these scenes. It seems to a number of people involved that the police are the key here—if they arrive, the ambulances will arrive. If the police see their responsibility as being available for these emergencies, that will be very helpful.

Lord Patel of Bradford: My Lords, in moving this amendment I will speak to Amendment No. 72D as well.
	We left this subject in Committee on something of a high note, with the Minister undertaking to consider this amendment during the Bill's passage. As I understood the noble Baroness, Lady Royall of Blaisdon, to have said earlier, the Minister is still considering it, so I hope this amendment may jolly him along.
	As there is no difference between us over the value of advocacy services, I shall not belabour that point. I remind the Minister—unnecessarily, I know—that the Mental Capacity Act is soon to come into force, with its special advocacy provisions. Indeed, the Government have made something of a virtue of this in public in the past week.
	This legislation has wide support among mental health practitioners and user groups. The Minister will not need reminding that the Mental Capacity Act provides a statutory duty on authorities to provide independent advocacy to persons who, for example, face serious medical treatment under the powers of that Act. The glaring lack of such safeguards for patients who are formally detained under the Mental Health Act is spelt out in Section 37(2) of the Mental Capacity Act.
	I believe that this distinction between the rights of patients under the Mental Capacity Act and the Mental Health Act is not only unethical in terms of equity of provision but dangerous. It is dangerous because we run the risk of having two statutes that have considerable overlap. The Mental Capacity Act is, and is seen to be, forward-thinking, concerned with patient rights and protections, and so on, whereas the Mental Health Act appears to be a set of second-rate provisions, outdated attitudes and the shifty machinations of a Home Office forever seeking unfettered powers of social control.
	Every time we allow some unjustifiable inequity between the way in which these two statutory frameworks deal with patients, we move a step closer towards the Manichean system of a nice mental health law and a nasty mental health law. The danger, as this House has heard before, is that the nasty mental health law drives away those whom we would wish to seek early treatment, not least on grounds of safety.
	Such concerns take us slightly away from the subject immediately at hand. To return to the question of advocacy, whether a detained patient is judged to be incapacitated or not in relation to certain decisions about his or her care, we must never forget that such decisions are taken within a framework of extraordinary disempowerment. I cannot see why patients detained under the 1983 Act should be any less deserving of statutorily-based advocacy services than incapacitated patients falling under the terms of the Mental Capacity Act.
	I hope that this puts some extra spark into the Minister's deliberations. I beg to move.